S1412 Investigating the Use of Carvedilol for Bleeding From Small Bowel Arteriovenous Malformations at a Tertiary Care Center

Introduction: Arteriovenous malformations (AVMs) can cause severe gastrointestinal bleeding leading to multiple hospitalizations. They are usually found in patients with renal, platelet, and cardiac diseases. Because of their size and location, they may be difficult to endoscopically diagnose and treat. Studies have shown that patients can be managed with octreotide, thalidomide, and bevacizumab but these medications can cause serious adverse reactions. Here, we will explore the effects of carvedilol in the management of small bowel AVM bleeding. Methods: This study was a retrospective chart review of hospitalized patients ages 18 - 99 at a tertiary care center who had small bowel AVM bleeding from 1/1/2016 to 12/31/2023. Patients were selected from the electronic medical record using ICD codes. The independent sample t-test, chi-squared test, and 2-tailed Mann-Whitney U test were used and the data was analyzed using Statistical Package for Social Sciences. P < 0.05 were considered significant. Results: There were a total of 44 patients for this study who were hospitalized for small bowel AVM bleeding, 19 were on carvedilol and 25 were not. The average ages between the 2 groups were similar, 78.5 vs 80.8 years (t = 0.88, P = 0.38). The differences in mortality (𝜒2 = 2.50, P = 0.11), number of comorbidities (𝜒2 = 13.14, P = 0.11), and location of AVMs were not significant (𝜒2 = 5.79, P = 0.22). The number of hospitalizations (U = 150.50, P = 0.02) and the number of blood transfusions (U = 153.50, P = 0.04) were less in the carvedilol group compared to the control group. The number of endoscopic procedures performed did not show statistical significance (U = 211.50, P = 0.53). Conclusion: Carvedilol is an alpha-beta receptor blocker that is used for hypertension, heart failure, and portal hypertension. This study showed that it can reduce the number of hospitalizations and transfusions needed for patients with small bowel AVM bleeding. This can help improve patients’ quality of life as AVM bleeding is a chronic disease without definitive therapy. However, the number of endoscopic procedures performed did not show statistical significance. This can be due to barriers from the patients or endoscopists that can affect the decisions to perform procedures which could not be accounted for in our analysis. Nevertheless, our study showed that carvedilol can be considered as another medication to help manage this disease. Larger randomized controlled studies will be needed to validate the effects seen.